Preemptive Analgesic Effect Research Articles

Evaluation of the pre-emptive analgesic effects of ketamine hydrochloride versus magnesium sulphate in patients undergoing elective abdominal surgeries

Evaluation of the pre-emptive analgesic effects of ketamine hydrochloride versus magnesium sulphate in patients undergoing elective abdominal surgeries

Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial.

Efforts have been made to minimize pain, prevent the development of needle fear, and promote positive experiences for children. The present study is designed to evaluate the effect of premedication with Ibugesic Plus before the administration of local anesthesia and extraction in children. The aim of the study is to assess the efficacy of preemptive analgesia on pain perception during local anesthesia administration and extraction in pediatric patients. A total of 104 patients aged 7-10 years were selected who needed primary molar extraction. Group -Ibugesic Plus syrup was given 30 minutes prior to extraction. Group II-Placebo solution (B-Folcin syrup) was given 30 minutes prior to extraction. Pain level, pulse rate, and SpO2 were assessed using the Wong-Baker Faces Pain Rating Scale (WBFS) and pulse oximeter after injection, after extraction, and postoperatively. The highest scores of pain were recorded after the time of injection and extraction. The patients who received preemptive analgesics (group I) reported significantly less pain than the placebo group (group II) at the time immediately after injection, after extraction, and 2 hours after extraction. The present study showed that preemptive analgesic administration may be considered a routine and rational pain management strategy in primary tooth extraction procedures in children. Preemptive analgesia can be given to patients prior to dental procedures to reduce postoperative pain. Virda M, Panda A, Kataria K. Effect of Preemptive Analgesia on Pain Perception in Children: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2024;17(8):913-917.

Effect of preoperative oral ibuprofen on postoperative pain after dental implantation: a randomized controlled trial

Objective: To evaluate the effect of preemptive analgesia with ibuprofen on postoperative pain following single posterior tooth implantation, aiming to provide a clinical reference for its application. Methods: A multicenter, randomized, double-blind, placebo-controlled parallel-group trial was conducted. A total of 82 participants were included in the trial, meeting the eligibility criteria from April 2022 to April 2024 at the Capital Medical University School of Stomatology (40 cases), Beijing TianTan Hospital, Capital Medical University (22 cases), Beijing Chao-Yang Hospital, Capital Medical University (20 cases). Participants were randomly assigned in a 1∶1 ratio to either the ibuprofen group or the control group, with each group comprising 41 individuals. Participants in the ibuprofen group received 300 mg of sustained-release ibuprofen capsules orally 15 min before surgery, while the control group received a placebo. Both groups received the same postoperative analgesic regimen for 3 days. Pain scores were assessed using the Numerical rating scale (NRS) at 30 min, 4 h, 6 h, 8 h, 24 h, 48 h, and 72 h postoperatively, and the additional use of analgesic medication was recorded from days 4 to 6 postoperatively. Results: A total of 82 participants were initially enrolled in the study, with 7 dropouts (4 from the control group and 3 from the ibuprofen group), resulting in 75 participants (37 in the control group and 38 in the ibuprofen group) completing the trial. There were no reports of adverse events such as nausea or vomiting among the participants. The ibuprofen group exhibited significantly lower pain scores at 4 h, 6 h and 8 h [1.0 (0.0, 2.0), 1.0 (0.0, 2.0), 1.5 (0.0, 3.0) ] postoperatively compared to the control group 4 h, 6 h and 8 h [2.0 (1.0, 3.0), 3.0 (1.5, 4.0), 2.0 (1.0, 4.0)] (Z=-1.99, P=0.047; Z=-3.01, P=0.003; Z=2.10, P=0.036). The proportions of patients requiring additional analgesic medication between days 4 and 6 post-surgery were 18.4% (7/38) in the ibuprofen group and 27.0% (10/37) in the control group, with no significant difference (χ2=0.79, P=0.373). The median additional medication usage postoperatively was [0.0 (0.0, 0.0) pills] in the ibuprofen group and [0.0 (0.0, 1.0) pills] in the control group, with no significant difference (Z=-0.78, P=0.439). Conclusions: Preemptive analgesia with ibuprofen effectively reduces postoperative pain following tooth implantation, representing a safe and effective perioperative pain management strategy.

Effects of tramadol hydrochloride preemptive analgesia in kyphoplasty of thoracolumbar osteoporotic fractures under local anesthesia

To explore preemptive analgesic effect of preoperative intramural tramadol injection in percutaneous kyphoplasty (PKP) of vertebrae following local anesthesia. From August 2019 to June 2021, 118 patients with thoraco lumbar osteoporotic fractures were treated and divided into observation group and control group, with 59 patients in each gruop. In observation group, there were 26 males and 33 females, aged from 57 to 80 years old with an average of (67.69±4.75)years old;14 patients on T11, 12 patients on T12, 18 patients on L1, 15 patients on L2;tramadol with 100 mg was injected intramuscularly half an hour before surgery in observation group. In control group, there were 24 males and 35 females, aged from 55 to 77 years old with an average of (68.00±4.43) years old;19 patients on T11, 11 patients on T12, 17patients on L1, 12 patients on L2;the same amount of normal saline was injected intramuscularly in control group. Observation indicators included operation time, intraoperative bleeding, visual analogue scale (VAS) evaluation and recording of preoperative (T0), intraoperative puncture(T1), and working cannula placement (T2) between two groups of patients, at the time of balloon dilation (T3), when the bone cement was injected into the vertebral body (T4), 2 hours after the operation (T5), and the pain degree at the time of discharge(T6);adverse reactions such as dizziness, nausea and vomiting were observed and recorded;the record the patient's acceptance of repeat PKP surgery. All patients were successfully completed PKP via bilateral pedicle approach, and no intravenous sedative and analgesic drugs were used during the operation. There was no significant difference in preoperative general data and VAS(T0) between two groups (P>0.05). There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). VAS of T1, T2, T3, T4 and T5 in observation group were all lower than those in control group(P<0.05), and there was no significant difference in T6 VAS (P>0.05). T6 VAS between two groups were significantly lower than those of T0, and the difference was statistically significant (P<0.05). There was no significant difference in incidence of total adverse reactions between two groups (P>0.05). There was a statistically significant difference in the acceptance of repeat PKP surgery (P<0.05). Half an hour before operation, intramuscular injection of tramadol has a clear preemptive analgesic effect for PKP of single-segment thoracolumbar osteoporotic fracture vertebral body under local anesthesia, which could increase the comfort of patients during operation and 2 hours after operation, and improve patients satisfaction with surgery.

Deep learning in oral surgery for third molar extraction: empirical evidence and original model

Preemptive analgesia is an analgesic intervention to influence postoperative pain sensation. Control of postoperative pain is a major challenge for any surgeon. Adequate control of postoperative pain continues to be a challenge for modern medicine. The advent of artificial intelligence (AI) in all spheres of life, including medicine, has created the technical ability to process a variety of types and characteristics of data related to many diseases. The application of artificial neural networks in medical science has made it possible to obtain an independent, objective assessment as a consequence of the application of preemptive analgesia. The data analysis by our original model, compared with the routinely used statistical methods, show the presence of a tendency for a positive effect of preemptive analgesia. In order to obtain an efficient self-learning neural network, it is necessary to use large arrays of properly selected data that fulfill the role of input parameters for the neural network. The results obtained from the original model used are comparable to the traditionally used statistical methods. This model objectifies to a certain extent the preemptive analgesia in the surgery of third mandibular molars.

Comparing the Effectiveness of Oral Celecoxib with Oral Tramadol as Pre-Emptive Analgesia in Ambulatory Surgery

Nociception pathway is thought to be pre-emptively inhibited in hope to reduce acute pain in an anticipated procedural related tissue injury intraoperatively or postoperatively when pre-emptive analgesics are administered preoperatively. High intensity of pain is expected after surgical removal of the third molar which is associated with jaw swelling and limited opening of the jaw. We compared the pre-emptive analgesia effect of oral celecoxib and oral tramadol in elective ambulatory dental surgery under general anaesthesia. Informed consents were obtained from 84 patients with American Society of Anesthesiologists (ASA) physical status I or II and aged between 18 to 56 years. They were randomised to receive either oral celecoxib 200 mg (Group A) or oral tramadol 50 mg (Group B) one hour before induction of anaesthesia. Intraoperative and postoperative fentanyl consumption were compared. Numeric Rating Scale (NRS), ranging from 1 to 10, was used to assess postoperative pain scores. Group A showed a significant reduction in fentanyl consumption intraoperatively compared to Group B (p=0.047). Both groups of patients experienced mild pain at various times assessed postoperatively ranging between 0-2 NRS scores. Comparison between the groups did not detect significant reduction in pain scores and postoperative fentanyl consumption. We concluded that neither medication was found to be effective as pre-emptive analgesia, however, intraoperative fentanyl consumption was reduced by pre-emptive administration of oral celecoxib.

Duration of the preemptive analgesic effects of low- and high-frequency transcutaneous electrical nerve stimulation in rats with acute inflammatory pain.

Transcutaneous electrical nerve stimulation (TENS) activates various pathways to induce antinociceptive effects, based on the frequencies used. This study evaluates the preemptive analgesic effects and their duration of low- (LT: 4 Hz) and high-frequency TENS (HT: 100 Hz) using a rat model of acute inflammatory pain. Acute inflammation was induced by injecting 1% formalin into the hind paws of rats. LT or HT was applied for 30 min before formalin injection. Pain-related behaviors, such as licking, flinching, and lifting, were recorded for 60 min postinjection. Immunohistochemistry was used to assess the number of phosphorylated extracellular signal-regulated kinase (pERK)- and c-fos-positive cells in the spinal cord. Naloxone, a μ-opioid receptors (MORs) antagonist, and naltrindole, a δ-opioid receptors (DORs) antagonist, were administered before TENS application. Pain behavior duration and pERK- and c-fos-positive cell expression were then measured. LT and HT pretreatment significantly reduced both pain behaviors and the number of pERK- and c-fos-positive cells postformalin injection. Naloxone and naltrindole partially reversed the effects of LT and HT, respectively. Notably, HT's analgesic effect lasted up to 120 min whereas that of LT persisted for 90 min. LT and HT effectively exerted their preemptive analgesic effects on acute inflammatory pain by inhibiting pERK and c-fos expression in the spinal cord. HT presented a longer-lasting effect compared to LT. MOR and DOR activation may contribute to LT and HT's analgesic mechanisms, respectively.

Comparison of Pre-emptive Analgesic Effect of Paracetamol, Ibuprofen, and Placebo in Reducing Post-operative Pain in Intra-alveolar Tooth Extraction at The University of Benin Teaching Hospital, Benin City. A Randomised Trial.

Objective: Pain is one of the most common postoperative complications of extraction. Thus, this study is aimed at determining the pre-emptive effectiveness of paracetamol and ibuprofen in the management of post extraction pain.&#x0D; Methods: A randomized, placebo‐controlled, single‐blinded comparative study of patients who needed intra-alveolar extraction of posterior teeth. Sixty‐nine patients aged 18 years and above were randomly assigned to one of three groups: (A) paracetamol 1g; (B) ibuprofen 400mg; and (C) placebo (calcium lactate) 300mg. Each of the three tablets was given 30 minutes before administration of the local anesthetic agent. The pain level was assessed using the visual analogue scale®. Chi-square (X²) test, one-way analysis of variance (ANOVA) with an appropriate post-hoc test was used. Level of significance was set at 95% (p-value &lt; 0.05).&#x0D; Results: Ibuprofen and paracetamol groups showed lower pain scores compared to placebo. Although, there was no significant difference between the VAS scores at the post-operative period (P= 0.080). There was a significant difference in time taken for use of rescue medication among the three groups (p = 0.022), with those in placebo group 8 times more likely to use rescue medication relative to the analgesics.&#x0D; Conclusion: The use of preemptive analgesics showed lower pain scores compared to placebo, and also significantly increased the time for use of rescue medication postoperatively.

Evaluation of Pre-emptive Analgesia in Total Knee Arthroplasty During Early Post-operative Periods.

Pre-emptive analgesia isexpected to decrease post-operative pain. The degree of soft tissue release is directly related to preoperative deformity; we presume the severity of pain has a similar correlation in patients undergoing total knee arthroplasty (TKA). The main purpose of this research was to evaluate the effects of pre-emptive analgesia of different drugs in TKA with different degrees of preoperative genu varus. In this prospective observational study, 67 patients were enrolled with different degrees of genu varus deformity. They were subdivided into two groups: those with ≥15° and those with <15° varus deformities of the knee. Etoricoxib 60 mg and pregabalin 75 mg were administered orally in all the patients as pre-emptive analgesia two hours before surgery. Parameters such as the amount of soft tissue release, visual analog score(VAS), knee range of motion, complications, etc. were documented from the pre-operative period to 72 hours post-TKA. With pre-emptive analgesia in post-TKA patients, the VAS score demonstrated a statistically significant difference at 24, 48, and 72 hours. The comparison of intraoperative flexion between <15° and ≥15° showed a statistically significant difference with pre-emptive analgesia in post-TKA patients. The use of etoricoxib 60 mg and pregabalin 75 mg, two hours before surgery reduced the pain scores in patients undergoing TKA with different degrees of genu varus and correlated with intraoperative parameters associated with soft medial tissue release for genu varus.

The effect of ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery: a randomized, double-blinded, clinical trial

BackgroundIntercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery.Methods126 patients, aged 18–70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded.ResultsVAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004).ConclusionsFor patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage.Trial registrationChinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019.

Melatonin as preemptive analgesic for intraoperative pain.

Several anti-inflammatory and analgesic drugs have been used to reduce pain and discomfort during periodontal surgeries. This study evaluates the efficacy of using melatonin and ketorolac for pain prevention during open-flap debridement surgery. This prospective randomized controlled trial was performed in patients who presented with chronic periodontitis after non-surgical periodontal therapy, requiring flap surgery. Group 1: Flap surgery following non-surgical periodontal therapy after one month with no oral administration of analgesic. Group 2: Flap surgery following non-surgical periodontal therapy after one month with oral administration of Ketorolac 400mg one hour prior to the surgery. Group 3: Flap surgery following non-surgical periodontal therapy after one month with oral administration of 2 mg Melatonin one hour prior to the surgery. VAS and FLACC score along with blood pressure, SPO2 and heart rate. Statistical analysis was done using SPSS software. The intragroup comparisons (control-test drug) demonstrated that melatonin and ketorolac showed positive preemptive effect which compared to the control with mean differences significantly different from zero. However, when melatonin and ketorolac were compared there was no significant difference in postoperative pain among patients. The adoption of a preemptive medication protocol using either melatonin or ketorolac may be considered effective for pain and discomfort prevention during and post open-flap debridement surgeries. Melatonin showed similar effect to gold standard ketorolac in terms of its preemptive analgesic effect additional to having anti-inflammatory effect. Further studies are required to standardize the protocol for using melatonin as preemptive analgesic for dental surgical procedures.

Effects of Early Weight-Bearing Treadmill Training Combined with Pre-Emptive Analgesia on Femoral Fracture Recovery.

The effect of pre-emptive analgesia plus early weight-bearing treadmill training (EWBTT) on healing and motor function recovery of femoral shaft fracture is not clear. A total of 60 SD male rats were randomly allocated into 4 groups: group A (pre-emptive analgesia with EWBTT), group B (pre-emptive analgesia with delayed weight-bearing treadmill training, DWBTT), group C (pre-emptive analgesia with no weight-bearing), and group D (EWBTT with no pre-emptive analgesia). All rats were molded by internal fixation with Kirschner wire after right femoral shaft fracture. In groups A, B, and C, tramadol was intramuscularly injected 15 minutes before surgery. EWBTT was performed at day 1 postoperatively in groups A and D, and DWBTT was performed at day 14 postoperatively in group B. Oblique plate test was accomplished to assess hindlimb motor function recovery of rats in each group. Status of fracture healing was assessed through digital radiography (DR). Hematoxylin-eosin (HE) staining and immunohistochemistry of bone morphogenetic protein-2 (MBP-2) and vascular endothelial growth factor (VEGF) in callus were performed to explore fracture healing. The expression of BMP-2 and VEGF protein in quadriceps femoris muscle was detected by Western blot technique and mRNA expression of BMP-2 and VEGF in callus ascertained via reverse transcription-polymerase chain reaction (RT-PCR) technique. For oblique plate test, rats in group A outperformed those in groups B and C at all time points after operation. DR image revealed that large numbers of callus growth, blurred fracture line, and obvious continuous callus passing through the fracture line can be found in group A at day 28 postoperatively, which is the best healing status among all groups. HE staining of callus confirmed the optimal effect of healing for rats in group A. VEGF and BMP-2 expression by immunohistochemistry showed a significantly higher positive score for callus in group A while those in group C being the lowest at all time points postoperatively. Significantly higher expression level of VEGF and BMP-2 protein was detected in quadriceps femoris muscle from group A, which exceeded those in all other groups at all time points. RT-PCR testing proved the highest expression of BMP-2 and VEGF mRNA in callus of rats from group A, significantly higher than those of other groups. Both pre-emptive analgesia and EWBTT can effectively invoke the expression of VEGF and BMP-2 and promote recovery of hindlimb locomotor function in rats with femoral fracture, and the combination of them leads to more superior results.

The Preemptive Analgesic Effect of Capsaicin Involves Attenuations of Epidermal Keratinocytes Proliferation and Expression of Pro-Inflammatory Mediators After Plantar Incision in Rats.

Subcutaneous infiltration of capsaicin, which initially activates transient receptor potential vanilloid1 (TRPV1) receptors, can subsequently desensitize TRPV1-expressing nociceptors and induce analgesia in different pain models. Yet, whether the modulation of keratinocytes may also contribute to the analgesic action of capsaicin treatment remains unclear. In a rat model of postoperative pain, we tested the hypothesis that subcutaneous injection of capsaicin inhibited the proliferation of epidermal keratinocytes and their expression of pronociceptive inflammatory mediators after plantar incision. The plantar incision model was carried out in the current study. Behavioral tests were used to evaluate postoperative pain-related behaviors in rats. Immunohistochemistry was used to investigate epidermal keratinocytes proliferation and expression of pro-inflammatory mediators in keratinocytes in rats. Behaviorally, plantar incision induced robust postoperative pain hypersensitivity. However, subcutaneous pretreatment of capsaicin (1%) but not the vehicle, prevented the development of postoperative pain. There was an increased proliferation of keratinocytes and the expressions of interleukin-1β (IL-1β) andtumour necrosis factor-alpha (TNF-α) in keratinocytes at 3 d and 7 d after plantar incision. However, these changes were also significantly attenuated by capsaicin pretreatment. Our findings suggest that capsaicin pretreatment may inhibit incision-induced keratinocytes proliferation and reduce their expression of pronociceptive inflammatory mediators under postoperative pain conditions, which represents a peripheral non-neuronal mechanism of capsaicin-induced analgesia.

Pre-emptive analgesic effect of ultrasound-guided quadratus lumborum block versus transversus abdominis plane block in laparoscopic cholecystectomy

Background Transversus abdominis plane (TAP) block creates satisfactory somatic analgesia at T6–L1 with minimal or no visceral blockade, whereas quadratus lumborum block (QLB) provides somatic and visceral analgesia of the whole abdomen. Aim To compare the efficacy of QLB with TAP block in controlling pain after laparoscopic cholecystectomy. Patients and methods A total of 70 patients with American Society of Anesthesiologists I and II, aged 18–50 years, who underwent elective laparoscopic cholecystectomy were allocated into two groups: group I (subcostal TAP block) and group II (lateral QLB). Results Pain scores were lower in group II compared with group I at 4, 6, 8, and 10 h postoperatively. The time of first rescue analgesia was prolonged in group II in comparison with group I. Heart rate and mean arterial pressure showed insignificant differences between the two groups intraoperatively. However, there was a significant decrease in heart rate and mean arterial pressure in group II compared with group I at 4, 6, 8, and 10 h postoperatively. There was no reported local anesthetic toxicity or technique-related complication in the two groups. Conclusion Bilateral ultrasound-guided QLB was more effective than bilateral ultrasound-guided subcostal TAP block in patients undergoing laparoscopic cholecystectomy with prolonged postoperative analgesia and less pethidine consumption.

The Effect of Pre-Emptive Analgesia on the Postoperative Pain in Pediatric Otolaryngology: A Randomized, Controlled Trial.

The aim of this randomized, controlled trial was to determine whether children undergoing otolaryngological procedures (adenoidectomy, adenotonsillotomy, or tonsillectomy) benefit from pre-emptive analgesia in the postoperative period. Methods: Fifty-five children were assessed for eligibility for the research. Four children refused to participate during the first stage of the study, leaving fifty-one (n = 51) to be randomly assigned either to receive pre-emptive analgesic acetaminophen (15 mg/kg; n = 26) or a placebo (n = 25) in addition to midazolam (0.5 mg/kg) as premedication. All children were anesthetized with sevoflurane, propofol (2–4 mg/kg), and fentanyl (2 mcg/kg). Postoperative pain was assessed using the Visual Analogue Scale (VAS), the Wong–Baker Faces Pain Rating Scale, and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. The postoperative pain was measured 1, 2, 4, and 6 h after the surgery. Results: The clinical trial reported a statistically significant correlation between administering pre-emptive analgesia (acetaminophen) and reducing pain in children after otolaryngological procedures compared to placebo. The ratio of boys to girls and age were similar among the groups (p > 0.05), so the groups of children were not divided by gender or age. Conclusions: Standard pre-emptive analgesia reduced the severity of pain in the postoperative period after otolaryngological procedures in children. Acetaminophen given before surgery reduces postoperative pain in children undergoing otolaryngological procedures.

Preemptive analgesia in the "non-tube no fasting" fast track program for resectable esophageal carcinoma.

BackgroundSurgery is the main treatment for esophageal cancer, but postoperative incision pain seriously reduces patients’ quality of life. The aim of this study was to investigate the feasibility and effectiveness of preemptive analgesia of the upper abdomen with ropivacaine in the “non-tube no fasting” fast track recovery program for esophageal carcinoma.MethodsWe retrospectively analyzed the medical records of patients who underwent minimally invasive esophagectomy (MIE) from February 2014 to August 2014. Patients in the study group underwent a conventional analgesia program together with local infiltration injection of ropivacaine in the upper abdominal incision 30 min before the operation, while patients in the control group underwent the conventional analgesia program alone. Ropivacaine was injected locally around the planned surgical incision, including intradermally, subcutaneously, in the fascial muscles, and in the parietal peritoneum layers. Li’s anastomosis method was performed in the neck after MIE. No indwelling chest tube or abdominal cavity tube was placed in any patients. The use of analgesic pumps in the two groups of patients was recorded.ResultsA total of 102 patients were enrolled in the study, with 52 patients in the study group and 50 patients in the control group. Patients in both groups completed the surgery successfully as planned, and the anesthesia methods and drugs used during the operation were the same. The surgical duration, blood loss, and the number of resected lymph nodes did not differ significantly between the two groups. Three patients in the study group and 10 patients in the control group used analgesia pumps (P=0.031). The visual analog scale (VAS) score at 30 days after surgery in the group with preemptive analgesia was significantly better than that in the control group (P=0.048).ConclusionsPreemptive analgesia for the upper abdomen with ropivacaine in the “non-tube no fasting” fast track recovery program for esophageal carcinoma is feasible and worthy of promotion.

Effect of preemptive intramuscular diclofenac on minimal effective-dose bupivacaine saddle block for minor perianal surgeries.

Background:Preemptive analgesics are commonly used to increase analgesic efficacy and patient satisfaction. The aim of this study was to evaluate the preemptive analgesic effect of intramuscular diclofenac on minimal effective dose spinal anesthesia for perianal surgeries.Materials and Methods:Fifty patients ASA I&II were divided randomly into two groups, control group (GC N = 25) and Diclofenac group (GD N = 25), both groups received saddle block with 5% hyperbaric bupivacaine 0.5 mL (2.5 mg). Thirty minutes before the saddle block, patients in GD received 75 mg (3 mL) diclofenac intramuscularly, whereas patients in GC received 3 mL saline intramuscularly. The differences in the time for the first analgesic request, postoperative analgesic consumption as well as, visual analog scale, were our primary outcomes.Results:Fifty patients (25 in each group) undergoing perianal surgery completed the study successfully. The time to the first request of analgesia was significantly longer in GD 511.8 (108.07) min. compared to the GC 179.56 (49.24) min with P = 0.00001, as well as the total consumption of rescue analgesic (tramadol hydrochloride) was significantly less in GD 66 (23.8) mg compared to 104 (28.5) mg in the GC with P = 0.00001.Conclusion:Preemptive intramuscular diclofenac sodium with minimal dose bupivacaine saddle block significantly minimized the postoperative analgesic consumption and delayed the first analgesia request after perianal surgery.

The effect of pre-emptive ibuprofen on post-operative pain after removal of lower third molar teeth: a systematic review.

Objective To investigate the effect of pre-emptive ibuprofen on post-operative pain after lower third molar surgery.Methods A search for randomised controlled trials was undertaken across the databases Medline, Embase, Cochrane Central and Dentistry and Oral Sciences Source. Citation searching was used to supplement the database search. Inclusion and exclusion criteria were used for independent double screening by two assessors.Results A total of five randomised controlled trials were included in the review. A risk of bias assessment identified some concerns in four of the included studies. One study was assessed as having low risk of bias. The important outcomes measured were post-operative pain intensity, total pain relief, use of rescue analgesia, time to rescue analgesia and total consumption of rescue analgesia. In two trials, pre-emptive ibuprofen was shown to significantly reduce pain intensity after lower third molar surgery compared with placebo. Two trials showed no significant difference between ibuprofen and placebo groups. Pre-emptive ibuprofen was shown to provide superior pain relief compared with placebo in the one trial measuring this outcome. Where the use of rescue medication was measured as an outcome, two trials showed that pre-emptive ibuprofen was superior to placebo, one trial showed that placebo was superior to ibuprofen and two trials found no significant difference between ibuprofen and placebo groups.Conclusion Due to the inconsistency of the results, there is insufficient evidence to support the use of pre-emptive ibuprofen for management of post-operative pain after lower third molar surgery. Further research into the effects of pre-emptive analgesia on the surgical pain pathway is required.

Efficacy of Preemptive Analgesia on Tourniquet and Postoperative Pain Relief in Open Carpal Tunnel Release: A Prospective Randomized Control Trial

Preemptive analgesia has been used to reduce postsurgery pain and improve patient satisfaction. The effectiveness of multimodal preemptive analgesia in open carpal tunnel release under local anesthetic with a tourniquet is still debated. This study aimed to determine the effectiveness of preemptive analgesia on the postoperative tourniquet site and the surgical site. A total of 44 patients were randomly assigned to one of 2 groups. An experimental group was given 300 mg of gabapentin, 200 mg of celecoxib, and 500 mg of acetaminophen 2 hours before surgery. Placebos were given to the control group. All surgeries were done under local anesthetic by a specialist hand surgeon. A tourniquet was inflated to the recommended pressure. The outcomes included the immediate postoperative tourniquet site pain scores, surgical site pain scores (at 1, 6, 12, 18, and 24 hours after surgery), and acetaminophen consumption in the first 48 hours. The immediate postoperative tourniquet site pain score in the experimental group was significantly lower than in the placebo group. Although the surgical site pain score in the experimental group was significantly lower than the placebo group at 1, 6, 12, and 18 hours after surgery, these differences were not clinically significant. In addition, there was no statistically significant difference in surgical site pain score at 24 hours after surgery. The amount of acetaminophen consumed during the first 48 hours after surgery was significantly lower in the experimental group than in the placebo group. Multimodal preemptive analgesia effectively reduced immediate postoperative pain at the tourniquet site in open carpal tunnel release. It also reduced postoperative acetaminophen consumption. Therapeutic II.

Evaluating the Preemptive Analgesic Effect of Photo-biomodulation Therapy on Pain Perception During Local Anesthesia Injection in Children: A Split-mouth Triple-blind Randomized Controlled Clinical Trial.

To evaluate the impact of photobiomodulation therapy (PBMT) on injection pain perception and compare it with a topical oral anesthetic gel. A total of 30 patients of 6 to 9years-old seeking pulpotomy treatment of maxillary secondary primary molars of both sides were considered for this split-mouth triple-blind randomized clinical trial. On one side of the maxilla, the low-level laser (diode laser, 808 nm, 250 mW; 16.25 J; 32.5 J cm-2 ) was irradiated upon the buccal gingiva of the tooth, while a Benzocaine 20% topical anesthetic gel was applied on the other side. A gel with the same taste (strawberry) was applied for the placebo. The Wong-Baker Faces Pain Rating Scale was used to evaluate the injection pain and postoperation pain at two timestamps, 1 h and 24 h after treatment. Patients' heart rate was also evaluated. Paired t, Wilcoxon signed-rank test, McNemar and Friedman tests were used for statistical analyses. Results demonstrated that PBMT could significantly decrease the injection pain perception and heart rate alternations compared to the topical anesthetic gels (P = 0.000). However, no significant differences were documented between the two methods concerning the 1-h (P = 0.26) and 24-h (P = 1.00) postoperation pain. PBMT can be an effective nonpharmacological technique for controlling injection pain.